RAJKUMARI AMRIT KAUR COLLEGE OF NURSING, LAJPAT NAGAR, NEW DELHI

NURSING MANAGEMENT, MASTER OF NURSING

ADVISOR : DR. (MRS) MOLLY BABU
HOD (OBG & GYNE)
SPEAKER : Ms SAVITA

TOPIC: OBJECTIVES, PHILOSOPHY, CURRENT TRENDS AND ISSUES OF NURSING MANAGEMENT

INTRODUCTION
Nursing has its own ‘identity’ as profession. It is no more a paramedical profession. This nomenclature in respect of
nursing personnel has long been dropped by W.H.O. but still some authorities call nursing as paramedical profession.
Such an attitude towards nursing has done considerable harm and lowered the image and status of profession.

Management is art of knowing what you want to do and then seeing that is done….in the best way and cheapes t
way…by securing maximum use of men and machine.

AIMS OF NURSING MANAGEMENT

To ensure effective utilization of resources for the attainment of goals and make decisions regarding-
 What activities are to be performed
 By whom to be performed
 Where these are to be carried out.

OBJECTIVES OF NURSING MANAGEMENT

DEFINITION:
Objectives are goals, aims or purpose that organizations wish over varying periods of time’.
-DE McFarland
A managerial objective is the intended goal that prescribes definite scope and suggests direction to the planning
efforts of a manger.’ -Terry and Frankin

Objectives are defined as the important ends towards which organizational and individual activities are directed.
-Weihrich & Koontz

IMPORTANCE OF OBJECTIVES
Objectives are very important as far as the management activities are concerned. Without objectives, planning is not
initiated. These lay down specific direction and measurable speed for the organization.

Action
An
Clear direction for
objective Sound basis for
gives Evaluation

The process of management starts with setting of objectives then the other managerial functions come into picture.
Only then the manager is able to measure the performance, once it is implemented as per plan.
Thus an organization without objectives is like a ship without a rudder. So objectives are the end points on which all
the efforts of the organizations cover.

NATURE OF OBJECTIVES
Objectives state the end results, but these are not the ends itself. The overall objectives need to be supported by sub
objectives and also as per the level in the hierarchy.

 Objectives form hierarchy

As the objectives ranging from the broad aim to specific individual objectives, right from top level to individual level.
 Multiplicity of objectives
An organization may have multiple objectives. In each level, there can be many goals.
 Objectives have time limit
The objectives need to frame keeping in mind the time. A quality without a time limit conveys no meaning.
 Objectives are inter- related and inter dependent
All objectives are inter- related and inter dependent as per the management functions. Each objective cannot be
achieved without considering the other one.
 Objectives have different priorities
Success of organization depends on a rational approach to objectives and determination of priorities. It means that at
a given time, the achievement of one objective may be relatively more important than that of others.

FORMULATION OF NURSING OBJECTIVES

All the Organizations need to set the objectives. Setting objectives are important; it focuses the organization on
specific aims over a period of time and can motivate staff to meet the objectives set. Objectives can be formulated on
the following bases.

 On the basis of national health policy

The national health policy is assumed to be logically determined by health needs or problems of the people.
Democratic and scientific techniques of administration demand the presence of permanent mechanisms for
consultation before decision are reached by the government.

 Needs of the population

Nursing objectives should be based on needs of the population and formulated to make a positive impact on the
health status of the people by ensuring at least basic or elementary level of promotive, preventive, curative and
rehabilitative nursing services for all. Objectives should be consistent with overall objectives and target set should be
focused on achievement of health for all.

 Priority areas for improvement of basic nursing and midwifery

Nursing objectives should be focused on rural population, weaker or neglected section of society and taking the
responsibility for assuring at least a minimum level of safe, sound and scientific nursing care services.

 Resources available
Nursing objectives must take into account the resources available, the most costly health care activities are not
necessarily the most effective. Objectives should be defined in a manner that these should be pertinent, logical and
precise and would be capable of implementation, observation and measurement, if possible.

 Active participation
Formulated objectives should be communicated, understood and accepted. Both the nursing personnel engaged in
carrying out the activities for achievement of objectives, and population that is to be benefited from them should be
aware of the results expected.

 Philosophy of nursing services

Keeping in mind the philosophy of nursing that is based on objectives of hospital/ care centre, the nursing objectives
are formulated.

 Accepted or approved by the administrators

As soon as the objectives of nursing services are framed, these need to be approved and accepted by the top level
institutional head. And these should be available in writing.

CHARACTERISTI CS OF NURSING OBJECTIVES

S : Specific
M : measurable
A : achievable
R : Realistic and Relevant
T : time bounded

CLASSIFICATION OF NURSING OBJECTIVES

(a) level of objectives
1. Major or organizational objectives
2. Departmental objectives
3. Group objectives
4. Unit objectives
5. Individual objectives

(b) Types of objectives

1. Profit objectives: these are framed according to owner’s point of view, where profit or money return is the
motto of having health or nursing services. These types are framed mostly in private sector. E.g money return
2. Service objectives: keeping in mind the patient’s interests. E.g values in services
3. Social objectives: these are formulated in the light of public interests who are concerned with their welfare.
E.g. values in the interest of public welfare
4. Personal objectives: these are based on employees, individuals, economical, social and psychological
satisfaction
(c) Based on Hierarchy or operational objectives:
1. Primary objectives: The main primary objectives of hospital services are to provide the curative services by
ensuring patient care to indoor patients.
2. Subsidiary objectives: these objectives are based on the managerial professional activities e.g human
relation, communication, teaching or research.

Nursing objectives specific to hospital nursing services

A primary objective of administrators of hospital nursing services will be to create an environment in which a nurse
manpower resources will be utilized, presented and developed to be the most effective element in achieving the
objective of the health care agency through the rendering high quality of nursing care services in an economic
manner. The major objectives are
 To provide efficient social life to nurses and thus prepare them in the art of living together.
 To bring school or college and community closer to each other.
 To help the nurses in unfolding, blossoming of personality.
 To enable the nurse to have the right type of philosophy in life.
 To conserve all the good practices and conventions of the past.
 To help in the realization of objectives of education as laid down by the experts according to their selected
vocation or profession.
 To bring harmony between and the tasks.
 To make maximum use of all educational facilities in order to attain the desired objectives and to help
minimize the wastage.
 To provide healthy atmosphere for experimentation and research.

AIMS AND OBJECTIVES OF EDUCATIONAL ADMINISTRATION

There are a number of aims and objectives of educational administration. But its main objective is to realize faithfully
the goals which are laid down by the country or the society. The educational administration is directly linked with
times prevailing in the society and also according to the place where the educational institution existed. Therefore,
educational administration exists only for the people and its efficiency must be measured by the extent to which it
society or the nation in a whole. therefore, aims and actives of educational administration are as given below:
 To provide efficient social life to the students and thus to prepare them in the art of living together.
 To bring school or college and community closer to each other.
 To prepare the students for some vocation or profession (i.e. nursing, medical, engineering, law, etc.) which is
according to their interest and ability.
 To help the students in unfolding and blossoming of their personality.
 To enable the students to have the right type of philosophy of life.
 To conserve all the good practices and conventions of the past. .
 To help in the realization of objectives of education as laid down the educational experts according to their
selected vocation or profession.
 To bring harmony between the plans and the tasks.
 To make maximum use of all educational facilities in order to attain the desired objectives and to help
minimize the wastage.
 To provide healthy atmosphere for experimentation and research.

PHILOSOPHY OF ADMINISTRATION

MEANING OF PHILOSOPHY:
Philosophy in management consists of an integrated set of assumptions and beliefs about the way the things are,
purpose of activities and the way these should be. The decision makers of the organization create these assumptions
and beliefs to define the vision of the organization. The assumptions and beliefs are explicit and implicit in the minds
of the decision makers.
The statement of philosophy is abstract and contains value statements about human being as clients, patients and
workers, about the work that will be performed by nursing personnel for the clients and self care; about nursing as a
profession about education as it obtains to competence.

NURSING PHILOSOPHY:
“A statement of foundational and universal assumptions, beliefs and principles about the nature of knowledge and
thought and about the nature of the entities represented in the metaparadigm, i.e. nursing practice and human heal th
processes” (By “Reed, 1995”)

Nursing philosophy can be defined as a conceptual model or framework providing a frame of reference for nurse to
guide their thinking, observations, interpretations and practices. (by Seedhouse,2000)

For example: Philosophy of nursing of the department of nursing services and patient care
‘Nursing is an art and a science dedicated to improving the physical and psychological well being of patients. The
department of nursing services and patient care supports the practice of nursing within the service, education and
research mission in order to benefit patients, the people of country, and the health care professions. We are
committed to excellence in practice, education, informatics, research and administration’.

BASES FOR DEVELOPING NURSING PHILOSOPHY

1. The concept of caring where cognitive, moral and attitudinal aspects are examined.
2. The importance of gaining a moral and political consciousness of assumptions underlying a nurse’s work.
3. A discussion of some ethical and other implications in adopting a systems approach to the nursing process.
4. An analysis of nursing theory and research which drawn attention to the value of non empirical work,
reiterates criticism of the objectives approach as a research tool

STANDARDS FOR EVALUATING NURSING PHILOSOPHY

1. The philosophy should be available in written form in nursing department.
2. It should be developed by nursing personnel, consumers and other health care workers.
3. It should reflect the meaning of clinical practice of nursing. The responsibility of nursing personnel are
advocated keeping in mind rights of individuals.
4. It should include humanity, society, health, nursing, nursing process and self care relevant to community, law
like external forces like personnel, clients, material resources, research, education and family.
5. It should support the philosophy of the organization.
6. It should give the direction to the achievement of the mission

The philosophy underlying the whole field of administration, particularly as it applies health work, is based on the
following key points.
1. Administration believes in cost-effectiveness
In the management or administration of any enterprise for organization, the quality, quantity and cost of the work
necessary to reach the objective of the enterprise are inter related factors which must be given constant attention.
If the resources of health work, trained persons and in finances were limited, the need for constant attention to the
factors would not be so great. But the limitation in the number of trained personnel and lack of adequate financial
resources are major obstacles to greatly improved health in world today.

2. Administration believes in execution and control of work plans

One of the greatest possible contributors to wastage of our precious resources, whether at the local, or national
level, is the failure of those at any level of administration, and at all stages in the management of the activity, to
base all decisions on verifiable facts. There should be no tolerating errors in administrative act ion, which occur,
because someone failed to get all those facts.

3. Administration beliefs in delegation of responsibility and authority

No administrator can do in detail all the work he is administering for; by definition of an administration managers
the work for others. Therefore, the principles of delegation of responsibility should be followed to the utmost
extent, consistent with efficiency and co-ordination of policy

4. Administration beliefs in human relations and good morale

Administration is deeply concerned with human relations. How the individual worker in any enterprise, including
health work, feel about a situation. Among non-financial factors contributing to good morale is a personal
satisfaction in knowing that a job is well done and the satisfac tion of being associated with an institution of which
one can be proud of.

5. Administration beliefs in effective communication

Staff must be adequately and correctly informed about plan, methods, schedules, problems events and progress.
It is necessary that instructions, knowledge and information be passed on for practical application to all
concerned, and that they be so clearly presented as to be rule out any misinterpretation or misunderstanding.
Proper and adequate communication is not just in one direction, it requires two way passage.

6. Administration beliefs in flexibility in certain situation

Administration must be completely flexible to meet the changing needs of the situation.

CURRENT TRENDS AND ISSUES IN NURSING ADMINISTRATION AND MANAGEMENT

Nursing as a profession has flourished from the time of Florance nightingale till present day nursing. At some levels in
nursing, the question of professionalism takes on immense significance. However, to the busy staff nurse- who is
trying to allocate client assignment for a shift , distribute the medications at 9am to 24 clients ;and supervises ward
aide, nursing students-the issue may not seem very significant at all.
ISSUES IN NURSING ADMINISTRATION
A. Profession in nursing
1. Status of nursing in society in the health care delivery system.
2. Values reflected in our nursing performances.
3. Attitude, human approach.
4. Quality in nursing vis-vis education and practice.
5. Unique function of nursing.
6. Different levels of nurses that we need in our country.
7. Define and delineation of nursing functions at the different level.

B. Nursing practice
1. In the community setting and in the institutional setting at the level of primary, secondary and tertiary
levels of care.
2. Are nurses as matter of policy conceited in all matters related decisions area for nursing practice.
3. Can it be said that nursing service rendered, reflect quality of nursing care. They do there have the
necessary back up support from the system for performing the way they are required to perform.

C. Nurse themselves
1. Long hours of duties with very little time for recreation.
2. Non availability of health care programme for nurses.
3. Pressure from influencing people.
4. Non involvement of nurses in nursing matters.
5. Poor pay structures.
6. Lack of security and safety.
7. Non availability of basic commodities like toilet facility, in residential accommodation of community
nurses.

NURSING AND MIDWIFERY SERVICES

The nurse to population/patient ratio is low compared to other countries. In 2014, the ratio was 1:2250 in india and
1:100-150 in Europe. This ratio in African countries, srilanka and Thailand is 1:1400,1:1100 and 1:850. Respectively.
Only 40% of registered nurses are active because there is no system of live register in india. Nursing positions are
created due to financial constraints, poor working conditions, low pay scale, emigration, retirement or death.
The role and responsibilities of nurses are not clearly defined. In India the nurse to doctor ratio is almost 1.5:1 while it
is 3:1 in developed countries. Working conditions in many hospitals and communities in India are poor and unsafe.
Medical equipments and supplies are inadequate. incentives are limited. Limited opportunities are available for carrier
advancement due to non creation and non existence of clinical speciality nurse and nurse practitioner positions.

COMMUNITY HEALTH NURSING SERVICES

At the community level there are no position for nurses. Health care is provided by auxillary nurse midwives, lady
health visitor and female health workers. Antenatal and delivery care are mostly provided by traditional birth
attendants, which result in high maternal and infant mortality rates.
In the community setting, it is observed that ANMs/LHVs face problem related to transportation, accommodation ,
gender base harassment, lack of security, incentive and carrier prospects, and inadequate provision of living with their
families and educating their children.

NURSING AND MIDWIFERY EDUCATION

There are 635 nursing school and 165 nursing college in India. Between September 2014 and October 2014, 61.2%
institutions were found unsuitable for teaching. The postgraduate curriculum in nursing is not adequate. Teacher with
masters and doctoral degree are few. Research and academic work is scarce.

MAJOR ISSUES
According to the existing situation in India, major issues that need to be solved are as follows:
1. Insufficient contribution of nurses and midwives to health acre development due to-
- Few position for nurses and midwives at the state and national levels
- Inadequate nursing leadership and strategic management
- Inappropriate nurse to population/patient ratio
- Inadequate preparedness of nurses and midwives
- Inadequate recognition of nurses status in the health care system
- Limited active involvement of professional organisations
2. Poor quality of nursing and midwifery care due to-
- Shortage of nurses and midwive due to-
- Inadequate number of nursing positions as per the recommended staffing norms
- Migration
- Insufficient number of nurses with bachelor and master’s degree and in clinical specialities.
3. Limited competency of nurse and midwives due to-
 - Ineffective regulation of nursing and midwifery practices
- Inadequate structure for nursing and midwifery practices
- Inadequate motivation to provide effective care
4. Poor quality of nursing education to produce qualified graduates for services due to-
- Limited involvement of nurses and midwives at the policy level
- Shortage of qualified nurse educators
- Inadequate infrastructure for nursing education
- Limited production of academic work and research
5. Limited role and authority of the INC in nursing development due to-
- Limited roles prescribed in the Indian nursing council act, 1947
- Insufficient information systems in nursing and midwifery services

MEETING THE CHALLENGES

1. Strengthen involvement of nurses in health and nursing policy formation and planning
a. Nurses need to study policy formulation and planning at all levels of education.
b. Networking within and outside the nursing profession should be built and strengthened.
c. Data and information on nursing and health should be available, updated and accessible online, if possible
2. Empower nurse leader
a. There should be nursing division led by a nursing director in hospitals.
b. The nurse director has to develop leadership and management skills to enhance the quality of the nursing
workforce and nursing care.
3. Establishing quality assurance system for the nursing services
a. A quality assurance system comprises vision, mission, objective, strategies and operational plans, nursing
service activity, nursing manpower management, roles and responsibilities, nursing standards, nursing
indicators, nursing research, nursing administration and management, resource allocation and financial
support.
b. The role of INC in regulating nursing practices should be strengthened by amending the nursing act to include
maintain of registration of qualified nurses, renewal of license and setting up o nursing services and nursing
education accrediting system.
4. Ensure nursing workforce management as an integral part of human resource planning and health system
development-
a. A well managed nursing workforce requires an effective and efficient nursing workforce policy and planning
b. As essential component off the nursing and midwifery development plan is manpower planning.planning can
prevent shortage of nurses and increase efficiency in development, utilization and development. It is
important to include nursing workforce management in human resource and health system development.
5. Enhance nursing autonomy in practices-
a. The role and responsibilities of nurses are identified by professional organisations, nursing education and
nursing services and they can be adapted and expanded to meet universal nursing standards.
b. In India there are a number of care activities that nurses can undertake because of their educational
background but cannot carry out because doctors do not delegate responsibility to them.
c. With complex health problems, have a better clinical judgement and can select the proper option for the
patient by using evidenced based practice.
6. Enforce implementation of recommended norms on nurse to patient ratio
a. In hospitals and community settings, there should be a norm or standard for nurse to patient ratio.
b. Norms recommended by the health manpower planning, production and management committee in 1986 and
INC for different wards and outpatient departments should be reviewed.
7. Create posts for professional nurses at the community level and strengthen the competency of the
auxiliary nurse-midwife
a. In india, there is a doctor and nurse at the community health centre but at the primary health centre and
subcentre, only the female health worker, ANM has to take care 5000 people, which prevents her from
providing effective health promotion activities, maternal and child care; conducting home visits and preventing
illness.
b. To ensure quality of service at all community level, a public health nurse should work with an ANM.
c. The ANM should be taught about infectious diseases and their prevention such as HIV/AIDS, TB, malaria and
be responsible for midwifery work in the community.
d. To ensure quality of care, the sub center and PHC, CHC and district should have the infrastructure given in
the table:

SUB CENTER - To be manned by 2 ANM with 2 yr training as per revised syllabus

Population 50000 - Male health worker and 1 PHN
- Strengthening the infrastructural facilities
PHC - 1 PHN practitioner and 1 PHN supervisor
Population 30,000 - 4 staff nurse for 24 hr services
CHC - 14 staff nurses
1 lakh population - 3 PHN supervisor
 - 1 PHN practitioner
- 1 independent midwifery practitioner
District level - Strengthen the institution of the DPHN officer to supervise and
monitor the nursing and midwifery system
- 2 PHN officers

8. Produce advance practice nurse

a. APN are prepared at the master’s level
b. An APN can be categorized into a clinical nurse specialist, nurse practitioner, nurse anesthetist and midwife.
c. APN’s have the competency of clinical judgement, leadership skills, are an agent of change, and help in
collaboration and communication.
d. To expand the role of nurse in india, APN programmes should be established and should be included in
manpower planning.
9. Ensure appropriate facilities and adequate me dical equipment and supplies
a. The health care facilities should have a standard for rooms and space for outpatient departments and in
patient wards, and a standard for essential medical equipment and supplies.
b. Adequate medical equipment and supplies provide the patient with proper treatment and care, reduce nursing
time and rate of infection.
10. Promote evidence based practice and nursing research
a. Nurses with a master degree should be encouraged to provide evidence, read nursing research and use
evidence to improve or change nursing practices
b. An information system and library should be provided.
c. Multidisciplinary research should be encouraged.
d. At the hospital there should be a person who is responsible for the nursing research activity including fund
seeking for research and building of research network.
e. Nurse educators should develop a short course training on evidence base and research or to supervise
research activity.
11. Establish a continuing a nursing education system.
a. The nursing service department or hospital should formulate a policy on staff development and set aside a
budget to strengthen their competency in providing quality nursing care. This is an incentive for nurses.
12. Strengthen payment scale, incentive systems and working conditions.
a. Good payment and incentive systems should be established.
b. A nurse’s job requires good knowledge, skills, hard work and commitment, the payment scale should be
increased.
c. Potential nurses should be encouraged to study for a higher degree and take study pay with leave.
d. Good working conditions including adequate and appropriate working facilities, cleanliness and safety can
also facilitate productive work and quality of life of nurses.
13. Ensure quality of nursing education by strengthening nursing programmes, in creasing qualified nurse
educators and allocating appropriate resources to maximize efficiency and effectiveness.
a. There should be a continuation degree to upgrade the standards.
b. The master of nursing programme should be focus on advance nursing practice.
c. The teacher for b.sc programme should be at least a master’s degree holder and have teaching experience
as prescribed by the INC.
d. Educators should co ordinate closely with the nursing staff in hospitals to achieve education that is relevant to
the needs of the service.
e. The curriculum should be revised regularly, and alumni and stakeholders should be involved in the process so
that the curriculum meets the demand of the society.

RECOMMENDATIONS
Policy level
1. Manpower planning and development for nursing must be an integral part of human resource planning of the
health system and should involve nursing experts and stake holders.
2. A study on nursing manpower should be carried out to support health ,manpower planning and development.
3. Adequate positions must be created for nurses working in hospitals and community to facilitate population
coverage, accessibi ity and quality care.
4. Budget allocation should be done for human resource development, research and infrastructure.
5. Pay scales, working conditions and incentive systems should be improved.
6. A policy on QA system for health care should be established and implemented.

NURSING EDUCATION
a. A collaborative research network should be established to strengthen research in nursing.
b. Nursing education should be upgraded to BSc. MSc and PhD levels.
c. The qualifications of the teaching facultyshould be strengthened, and facilities and equipment provided to
facilitate quality nursing education.
d. Clinical practice and supervision should be strengthened.
 e. Nursesshouldbe empowered so that they can be involved in policy decisions by enhancing leadership,
communication and public speaking skills.
f. There should be conformity of nursing education standards with QA systems. .
g. APN programmes should be created to train nurse specialists.
h. Creative critical thinking and innovation in education and practice must be encouraged.

NURSING SERVICE .
a. Identify clearly the roles and responsibilities of nurses at each level.
b. Establish a QA system for the nursing service and and ensure implementation of car standards and norms.
c. Create the post of Advanced Nurse Practitioner.
d. Establish networking among nursing directors and educators to develop and implement nursingservice
planning an development.
e. Strengthen independent nurses‘ role in the health care service.
f. Demonstrate to the public the quality of nursing service: at all levels.
g. Enhance continuing education for nurses to improve quality care.
h. Plan to budget for appropriate equipment and facilities.
i. Utilize research findings and evidence-based nursing practice.
j. Establish training programmes for independent nurse practitioners.
k. Create positions for independent nurse practitioners.
l. Submit a proposal to request for the improvement of working conditions. pay scales and incentives
m. lmprove leadership and management skills of nurses by continuing education, training or direct experience
and a mentor system.

PROFESSIONAL ORGANIZATIONS AND REGULATION

1. Establish a system for renewal of licenses
2. Develop a comprehensive information system on nursing t/ and midwifery in the areas of education, service,
clinical practice and management of workforce.
3. Conduct an assessment of the nursing and midwifery man~ power according to the need for education and
service.
4. Develop an in-service education centre for nursing.
5. Ensure active participation of nurses/midwives in multidisciplinary teams to advocate health regulation.
6. Increase awareness among nurses and midwives on councils and regulations.
7. Strengthen the infrastructure and manpower in the INC i.e create position s of joint secretory and deputy
secretory(nursing)
8. Create positions of Nurse Registrar and Deputy Nurse Registrar in the State Nursing Councils.

Nursing scenario in India

Many States in India face a shortage of nurses and midwives. Most of the states have no system of re -registration of
nurses. About 13-28 lakh nurses and 6.18 lakh ANMs have been registered with the various State Nursing Councils.
However, only 40 percent of registered nurses in India are in service, the said figure includes all the nurses who have
been trained since 1947 (Source: Address by Shri T. Dileep Kumar, President, INC published in The Nursing Journal
of India, Jan.-Feb., 2013 Vol.CIV No.1).

Nurse to Population/Patient Ratio in India

Country Nurse to Doctor Nurses and Midwives/population Nurses midwives/

patient
India 1.5:1 1:1100 1:40

Nursing staffing and patient care

Overworked and underpaid nursing staff member are demotivated and dissatisfied and have impact on patient safety
issues; patient care suffers and lack of time can lead to poor patient nurse communication. Quality of care also
suffers. Understaffing and the consequent additional workload on nurses have been shown to:
 Stress and burnout among nursing personnel
 Violations or work-around by nurses
 Have a significant impact on nosocomial infections
 Reduce time nurses have to help other nurses.
 Difficulty in training or supervision of new nurses.

Nursing Structure at Ministry of Health and Family Welfare

Secretary Health
 Addl. Secretary Health

Joint Secretary

Director Nursing Nursing Advisor

Deputy Secretary Asstt. Director-General (Nursing)

Under Secretary Dy. Asstt. Dir.-General(Nsg) Dy. Nursing Advisor

Section Officer (Nursing) Nursing Office

In the light of the above, the following recommendations are made:

• The post of Nursing Advisor to be kept at par with Joint Secretary of MoHFW, GoI. (the qual ification would also be
enhanced to PhD as mandatory).
• The post of Assistant Director General (N) to be kept at par with Director of a Ministry/Department
• Dy. Nursing Advisor and Deputy Assistant Director General (N) to be kept at par with Deputy Sec retary in the
Ministry/Department
• Nursing Officer to be kept at par with Under Secretary of the Ministry/Department

Nursing Cadre in Health care System

Nurses play important role in the health delivery system. Nursing profession is broadly divided into three distinct
categories depending upon their area of work. These are:
1. Nursing Directorate/Division at the Ministry of Health and Family Welfare, GoI
2. Nursing Education and Research
3. Hospitals services
4. Public/Community Health.

Nursing Education/Research system in India

The nursing education, in tune with National Health Policy, is continuously being monitored, certified and accredited.
Thus uniformity, order and control are brought to nursing education and training so as to prepare them to work in
various health sectors and National Health programmes in the country.

Cadre in School of Nursing

After the implementation of the recommendations of the 6th CPC, there has been no difference in the grade pays
between Sister Tutor and Senior Tutor, both getting same grade pay of Rs. 5400/- in schools of nursing, which is not
logical.
Rectification leads to cascading effect of same grade pay for Senior Tutor and Vice Principal, and for Principal and
Vice principal.

Cadre in College of Nursing

There is no difference in the grade pays between and the Sister Tutor and Senior Tutor resulting in both categories
getting same grade pay of Rs.5400/- in colleges of nursing. The Senior Tutors/Lectures have to be granted the grade
pay of Rs. 7600/- and Rs. 8700/- respectively to rectify the anomaly. Rectification leads to cascading effect of same
pay.

Nursing faculty of all Colleges of Nursing should be granted UGC Scales and nomenclatures.
Currently the Sister Tutors are promoted nearly after 10 years of experience to the post of Senior Tutor in Colleges of
Nursing. It was observed that the 6th CPC has given same grade pay between the cadres of Sister Tutor and Senior
Tutor. Currently the pay band is 3 for both the cadre and GP is Rs.5400/ - only. This anomaly can be resolved by
enhancing the GP to Rs. 7600/- for Sister Tutor and Rs. 8700/- for the Senior Tutor. Due to cascading effect, it is
essential to increase the grade pay of Lecturer/Asst. Professor, Associate Professor and Professor. Hence the GP of
lecturer/Asst Professor needs to be increased to Rs 8900/-, Associate Professor to Rs. 10,000 under PB 4, Professor
PB4 with GP Rs. 12,000/-.

Cadre in Hospital Nursing Services:Currently, the Assistant Nursing superintendents are promoted after 5 years of
experience to the post of Deputy Nursing Superintendent. It was observed that the 6th CPC has given no difference in
the grade pay between the cadres of ANS and DNS. The Assistant Nursing superintendents is feeder ca dre for
promotion of 18. Deputy nursing superintendent which is only 1% of total nursing cadre and essentials required for
better management of health delivery system in hospitals.
Due recognition must be given to graduate nurses and postgraduate nurses so as to retain higher degree nurses to
stay in clinical-services side to upgrade the standard of nursing practice.

Anomalies in Nursing Education

After the implementation of the recommendations of the 6th CPC, there is no difference in the grade pays between
Sister Tutor and Senior Tutor. As a result both the categories are getting same grade pay of Rs.5400/ - in schools of
nursing. Rectification leads to cascading effect of same grade pay for Senior tutor and Vice principal, and for Principal
and Vice principal.
There is no difference in the grade pays between and the Sister Tutor and Senior Tutor resulting in both categories
getting same grade pay of Rs.5400/- in colleges of nursing. The Senior Tutors/Lectures have to be granted the grade
pay of Rs. 7600/- and Rs. 8700/- respectively to rectify the anomaly. Rectification leads to cascading effect of same
pay:
Sr. Tutor/Lecturer and Sr. Lecturer/Asst. Professor Sr. Lecturer/Asst. Professor and Reader/Associate Professor
Reader/Associate Professor and Reader.

b) Anomalies in Nursing Service

Currently, the Assistant Nursing superintendents are promoted after 5 years of experience to the post of Deputy
Nursing Superintendent. It was observed that the 6th CPC has given no difference in the grade pay between the
cadres of ANS and DNS. The Assistant Nursing superintendents is feeder cadre for promotion of Deputy nursing
superintendent which is only 1% of total nursing cadre and essentials required for better management of health
delivery system in hospitals.
After the implementation of the 6th CPC, the post of ANS and DNS have been placed in pay band-3 with the same
Grade Pay of Rs. 5400/-.

c) Anomalies in Public Health Service

The feeder post of PHN (N) and the promotional post PHN Senior in the Central Government institutions are given
Grade Pay of Rs. 4800/- and Rs. 5400/- respectively. However, the post of PHN in AIIHPH, Kolkata has been given
the Grade Pay of Rs. 4800/- and the promotional post of PHN Supervisor could not be extended the higher grade pay
of Rs. 5400/-, on account slight difference in the nomenclature of the post.
The Grade Pay for the ANM and LHV being meagre, is required to be stepped up.

ISSUES RELATED TO SALARY STRUCTURE

1. Nursing Allowance (NA)
In the VIth Pay Commission, nursing allowance was enhanced from Rs.1600 to Rs.3200 per month. Presently,
nursing allowance is Rs. 4800 p.m. it is demanded that the provision of nursing allowance to all the nurses at all
levels, irrespective of their status and nature of job may be made and it should be increased 3 times of the present
allowance.

2. Non-Practicing Allowance (NPA)

All the Nursing services justifies for providing NPA because it will affect the regular services provided to the
consumers.
The non-practicing allowances to be granted to the tune of 25% of basic pay and should also be counted for all other
benefits like DA, pension, travel etc. as with medical practitioners.

3. Qualification allowance:
The Post-Graduation holder should be granted one extra increment over the Graduate Nurse.

4. Incentives for Ph.D and M.Phil Qualification

The persons having completed Ph.D qualification should be entitled to 3 non-compounded increments. The M. Phil
degree holders shall be entitled to 2 non-compounded increments.
Academic Grade Pay (AGP) to be followed as per UGC pattern.
Assistant Professor with completed service of 5 years shall be eligible for Academic Grade Pay.

5. House Rent Allowance

As Nursing staff welfare measure, it is proposed to continue allotment of accommodation on priority basis, provide
residential accommodation within the hospital premises so that they are available during any kind of emergency to
atleast 40-50% of the total number of nurses within the hospital premises/ campus or closer to the hospital, i.e. within
radius of 1 km of the hospital.

6. Telephone/mobile/ internet allowance

To be given to all nursing personnel and to be enhanced accordingly.

7. Conveyance Allowance
PHNs cover wider area in performance of their duties. They cater large number of population at their doorstep in
implementation of National Health Programme. The transport system (pick and drop) may be arranged in such a
manner that it coincides their shift duty timings. The driver and vehicle arrangement may be done to protect the
modesty of nurses.

8. Telephone/mobile/ internet allowance

To be given to all nursing personnel and to be enhanced accordingly.

9. Conveyance Allowance
PHNs cover wider area in performance of their duties. They cater large number of population at their doorstep in
implementation of National Health Programme. The transport system (pick and drop) may be arranged in such a
manner that it coincides their shift duty timings. The driver and vehicle arrangement may be done to protect the
modesty of nurses.

10. Newspaper Allowance

All the employees working in Government setup at par with Nursing staff are getting Newspaper allowance. The
provision to be made for the Nursing personnel also.

11. Continuing Nursing Education/In-service education

The Government of India has made it mandatory to undergo 150 hours of CNE training programmes every five years
for the purpose of re-registration. However, sufficient number of CNE training programmes are not available and the
Nurses are not deputed to such training programmes on the pretext of shortage of staff. As a result, the nurses are
not in a position to update their knowledge and skills in the emerging areas of specialisati on in the field of health and
nursing.
it is recommended that the institutions and authorities should allow the nursing personnel adequate opportunities to
undergo such training programmes and the trainees should be granted CNE allowance to cover registration fee, travel
and boarding & lodging.

12. Washing Allowance

The existing washing allowance of Rs.450/- per month is too meager. It needs to be revised to above Rs.2000/- per
month considering the increase in cost of living (washing, ironing, dry -cleaning etc.).

13. Overtime Allowance

On account of acute shortage of Nurses, Nurses have to perform overtime duty on many occasions so that delivery of
health care to needy patients is not affected. In the Indian Railways, Nurses are being paid overtime allowance. In the
light of the above, it is recommended that Nurses doing overtime may be paid overtime allowance at the rate
admissible to Government employees.

14. Uniform Allowance (UA):

Allowance may be given annually at the rate of Rs. 1000 to 3000 as a lump sum amount. it is proposed that the
yearly uniform allowance should be revised from Rs.9000/- to 22, 500/-.

15. Special Allowance:

The VIth Central Pay Commission recommended to enhance special allowances of Rs.120/ - per month to Rs. 960/- to
nurses working in special units viz. ICU, CCU, NICU, Operation Theatre, dialysis, burns subject to the condition that it
shall not be granted to more than 35% of the total nursing staff.
Nurses with special training (such as oncology, neonatal intensive care, critical care prescribed and recognised by the
Indian Nursing Council) in super-specialty units are already working in many Central Govt. hospitals in India.

16. Risk Allowance

Nurses are exposed to more occupational hazards than other health professionals owing to the continuous/ long
hours of direct contact with the patients, unsafe environment, inadequate supply of bare essential items like soap
antiseptics and sanitisers, needle destroyer, protective devices like gloves, plastic aprons/ gowns, sleepers. The
adverse unsatisfactory ratio of Doctor to nurse (3:1) and patient to nurse (200:1) expose nurses to multiple risks.

17. Field Allowance

There are instances of high risk involved in discharge of duties instantly, hardships faced by the field staff in
comparison to office environment regarding general facilities & utilities even the non-availability of drinking water,
toilet and public assault. Field allowance to be given to Public health nursing staff working in Community/Public health
such as OT allowance is given to nursing staff in hospitals.

18. Rural/ Hill/Difficult Area Allowance

The Nursing personnel working in rural/ difficult areas (e.g., forest belts, hilly areas, islands et c.) and semi-urban
areas should be given a special allowance to cover additional expenses due to inadequate transport facilities, lack of
educational facilities, and other parameters relating to the quality of life. This allowance should be at par with oth er
professionals working in Rural/Difficult areas similar to those of nurses.
 19. Learning Resource Allowance
If the individuals submits the concept/research paper and it is accepted they should be permitted to participate in 2
National and 2 international conferences alternately.

20 Administrative allowances
Nursing personnel working in Apex Bodies e.g. Nursing Adviser to the Govt. India, MoHFW, Secretary - INC, Principal
and Vice-Principal of SON/CON
- As applicable to other Govt. employees

RECOMMENDATI ONS FOR FACULTIES

a) CRÈCHE FACILITY
Majority of the nurses are women who enter the service at the age of 21 years. Almost 45% of nurses are in the
reproductive age group. Being women the onus of rearing the children and looking after the family is with them.
It is also recommended by Central Govt. that there should be crèche facility in the working place where a minimum of
30 women are employed.
b) FACILITY DURING NIGHT DUTY
Nurses on night duty remain in the ward for almost twelve (12) hours. The working conditions in the wards are
generally poor and inadequate to meet the needs of the nursing personnel on duty at night. Suitable infrastructural
facilities such as nurses duty room, provision for easy chair/recliner in the ward for taking rest at least for 3 hours
while on night duty and provision for refreshments should be made which will have direct implication on patient care.

OTHER RECOMMENDATIONS
 Employment: Uniformity in employment procedure to be made and Recruitment rules to be uniformly made
for all the categories of nursing posts.
 Job description for all categories of nursing personnel (prepared by TNAI Action Core Committee) to be
approved and circulated to all the hospitals/institutions with the strict guidelines to implement these.
 Working hours: Pattern of working hours should be uniformed in all the hospitals/institutions

Harassment of Nurses by Others

There are some instances occurred in various circumstances in different places, harassment of nurses by clerical
staff, it while taking their salaries and claiming other arrears leave of their own credit and some times by the
administrators of the institution. On many occasion GNAK intervened and solved those problems to some extent.
Nurses working 1n between doctors on one side and the other side Group _D_ officials are facing so many problems.
Nowadays it is very difficult for nurses to control the Group D officials for so many reasons.
To control these groups, co-ordination and cooperation is needed from the administrators of the institution and higher
authorities.

TRENDS IN NURSING MANAGEMENT

Trend: a trend means a change that is taking place in present days or movement in a particular direction.
TRENDS IN NURSING
Historical perspective:
Nursing has developed to their present status over the last hundred years. There has been much variation in the rate
of development even though there are similarities in the basic patterns. So,
A. Before independence
Shortly after the criminal war, in which Florence Nightingale played a notable role, she sent questionnaire to
all british Military establishments in India for the purpose of obtaining figures of sickness and mortality rate
among soldiers, as also amenities in the hospitals attached to Indian Cantonments. Recommendation made
are:
1. In 1888, Indian army nursing services were set up.
2. Mission hospitals were being set in different parts of India at about the same time. Religion prevented hindu
and muslim girls from joining, so only Christian girls could be trained first.
3. Ms Atkinson was brought from England to Bombay to set up and become superintencent of first modern
training school nurses in India in 1891.
B. After independence:
1. Greater opportunities for further study and wider professional contacts, both at home and abroad have
become available. The changes took place from past to present in nursing are depicted below in table

AREAS PAST PRESENT

Focus Hospital Community
 Purpose curative Promotive and preventive
Nature General Specialized
Simplicity Bedside High-tech
Assignment Functional centered Patient centered
Patient perspective Patient as individual identity Holistic approach
Role Basic role Multi roles
Practitioner Dependent role Independent practitioner

EMERGING TRENDS IN NURSING PRACTICE:

1. Changing Demographics and Increasing Diversity
There is a significant increase in the diversity of the population which affects the nature and the prevalence of illness
and disease, requiring changes in practice that reflect and respect diverse values and beliefs. Disparities in morbidity,
mortality, and access to care among population sectors have increased, even as socioeconomic and other factors
have led to increased violence and substance abuse. Ethnic and racial diversity of nursing institutes has increased
dramatically, creating a rich cultural environment for learning. Older aged students bring varying college and wor k
experiences, as well as more sophisticated expectations for their education. Nursing practice, education, and
research embraced and responded to these changing demographics. Nurses are now focusing on spiritual health, as
well as the physical and psychosocial health of the population. Nurses must focus on spiritual health, as well as the
physical and psychosocial health of the population.

2. The Technological Explosion

There is reduction in distance through speedy communication. Advances in digital technology have increased the
applications of tele-health and telemedicine mobiles, e-line, video conferences, bringing together patient and provider
without physical proximity.
Nanotechnology is a new form of clinical diagnosis and treatment, which is capable of detecting a wide range of
diseases from very minute specimens. There is computerization for patient care management. Easy reference on
directions for patient care, record keeping, reporting, compilation of information, stock monitoring, auditing are some
of the functions which computers have taken over ability to use computers for patient care management have become
essential qualification for nurses. Accessibility of clinical data across settings and time has improved both outcomes
and care management. Electronic recording replace traditional documentation systems. Through the Internet,
consumers will be increasingly armed with information previously available only to clinicians.

3. Globalization of the World’s Economy and Society

With the “death of distance” in the spread of disease and the delivery of health care, posing both extraordinary risks
and benefits. Now there is potential for rapid disease transmission & potential for dramatic improvements in health
due to knowledge transfer between cultures and health care systems. Nursing science needs to address health care
issues, such as emerging and remerging infections, that result from globalization. Nursing education and research
must become more internationally focused to disseminate information and benefit from the multicultural experience.

4. The Era of the Educated Consumer, Alternative Therapies and Genomics

People have knowledge about health promotion as well as disease prevention and also there is an increased
acceptance and demand for alternative and complementary health options. Increase in gene mapping will drive rapid
advances in the development of new drugs and the treatment and prevention of disease. Nursing research has the
potential to enhance knowledge regarding what constitutes a “healing” therapy. Nursing education and practice must
expand to include the implications of the emerging therapies from both genetic research and alternative medicine,
while managing ethical conflicts and questions.

5. Quality assurance in nursing care

Public knows their rights, human rights, commissions , protection acts and process etc, are putting constant pressures
on the professionals to deliver their best. Professionals cannot ignore or be careless in discharging duties especially
when it concerns people lives and health .Nurse managers have to ensure delivery of quality care by practicing as per
standards laid down by their counsels and institutions.

6. Decentralised approach to care management

This makes each and every nurse responsible and accountable for the care of assigned patients .This approach is
found applicable and effective in terms of patients satisfaction, quality care and smooth functioning of the units.The
trend in span of authority appears to be towards large numbers. This is not the result of efforts to increase the span
but rather to reduce the number of organizational levels for a given structure. Too many organizational levels impede
communication. This forces the executive to select subordinates with good potential or proven execut ive ability.

7. Interdisciplinary Education for Collaborative Practice

There is a need for coordinated care and a significant increase in the use of midlevel providers, such as ANPs, as
part of the health care team. There is an increased collaboration between nursing practice and nursing
education.Team-based, interdisciplinary approaches are highly effective for improving clinical outcomes and reducing
cost. There is a growing need of teaching methods that incorporate opportunities for interdisciplinary educa tion and
collaborative practice.Now a days there is increased emphasis on collaboration between healthcare disciplines. Also
there is increased student and nurse mobility (including increased licensure mobility),increased distance (online)
learning. Schools of nursing providing ongoing professional development for competence requirements. Also there is
an increased teaching of evidence-based practice.

8. The Current Nursing Shortage, Opportunities for Lifelong Learning and Workforce Development
There is significant nursing manpower shortage both in acute and long-term care settings.
As the age of entering students rises, the number of years of practice decreases also affects supply. While the
number of male and minority students has been steadily rising, their ranks are still underrepresented.
Workforce Continuing & in-service education is introduced for the working nurses.
Concept of supportive supervision is coming up. Supportive supervision is a process that promotes quality at all levels
of the health system by strengthening relationships within the system, focusing on the resolution of problems, and
helping to optimize the allocation of resources. It focuses on problem solving on the spot with the joint participation of
the supervisee and supervisor.

9. Continuing nursing education

It has become essential to keep up with the changing needs of patient care. Nurses have to continuously update
themselves with new and innovative approaches in patient care management. For this they should enable themselves
with workshops, seminars, short term training programmes, attend conferences, make use of library, subscribe and
read periodicals and books. Discussion on bedside and supportive supervision helps to keep abreast with newer
techniques and information.

10. Evidence based practice

There has been a significant Advancement in Nursing Science and Research. The growing body of nursing research
provides a scientific basis for patient care and should be regularly used by the nurses. Most studies concern health
behaviors, symptom management, & improvement of patients’ and families’ experiences with illness, treatment, and
disease prevention. There is lack in focus on the scholarship and science of nursing as top priorities. Doctorally
prepared nursing professionals are not being produced in large enough numbers to meet the growing need. There is
need for enhanced mentorship for new researchers to strengthen skills and capacity to conduct meaningful nursing
research.

11. Nursing audits

A careful review of nursing care and its effectiveness is done by the administrators of nursing services. Not only
clinical improvements but also emotional aspects of the patient need to be measured to decide the quality of nursing
care given.

12. Collective bargaining

The image of nursing has always been one of dedication, service to the patient, and selflessness. Now as nursing
profession, the issue of collective bargaining has become more important. Collective bargaining is the uniting of the
employees for the pupose of increasing their ability to influence their employer and to improve the working conditions.
Collective bargaining is based on the principle that there is greater strength in large numbers. The nurses who have
joined nursing unions have increased. Nursing practices have often been defined and controlled by other groups also
such as physician and hospital administrators. These groups saw the potential power of an organized large group of
well educated and dedicated nurses and feared the time when they would become independent. Even though , in
area of the country where collective bargaining of health care workers is not the part of the system, many hospital
administrators react to any unionization attempts on the part of nurses with hostility and resistance .

13. Case management, disease management, and telehealth care expand:

there is a demand to manage the care from a distance, being more people at home and in remote areas with chronic
diseases and complicated treatment regimens, through the use of telephones, television monitors, and
telecommunication.

14. Nursing education go online

Various courses of nursing education will go online in future.

15. Wellness centers, Holistic and Alternative therapies

There is a great focus on promoting health and triggering the body’s natural healing powers through holistic and
alternative therapies (e.g exercise, massage, acupuncture etc.)

RESEARCH ARTICLE

ISSUES AND TRENDS IN NURSING SERVICE ADMINISTRATION EDUCATION.

 1. Tilbury MS 2012 Feb;22(2):13-4.
The Council on Graduate Education for Administration in Nursing (CGEAN) was established to further the
development and improvement of graduate education for administration in nursing. The Council seeks to identify the
nature and direction of education for administration in nursing in various healthcare systems, providing guidelines for
programs offering administration. A major goal of CGEAN is facilitating dialogue between nursing service
administrators and graduate level educators who are engaged in teaching and research related to administration in
nursing. This column, sponsored by members of the Council, will analyze and respond to position statements and
trends related to the delivery of health services and graduate education for administrators in nursing.

2. Lawrence h ganong in 2014 published an article in journal of family nursing on the topic current trends and
issues in nursing management. The purposes of this article are: (a) to examine current trends and issues in family
nursing research from the perspective of an intimate outsider to the field, and (b) to offer predictions regarding future
trends for nursing management. The article is divided into three sections. First, the unique dimensions of families are
identified and the problems these characteristics present to res earchers are briefly examined. Second, a brief
overview of the topics studied in family nursing research and the methodological issues of that body of literature are
presented. Finally, conclusions are drawn and observations are made about the current stat us of family nursing
research, and recommendations for the future are offered. Among the predictions are an increase in multidisciplinary
research teams, greater use of midrange theories, an increase in conceptual and methodological complexity, more
study of family diversity, greater use of feminist frameworks, and an increase in the number of Family nursing
scholars who have programs of research.

3. A qualitative descriptive study was conducted by Rathi Balachandran on challenges of nursing sisters in
government hospitals among 36 nursing sisters of Central government hospitals in Delhi by focus group discussion.
Challenges identified were managing staff performance, lack of role clarity and powerlessness in the system.
Solutions suggested by nursing sisters were formal education in management, communication skills, managing staff
performance and development and leadership support.

MATERIALS AND METHODS

A qualitative descriptive design was used to obtain direct information via focus groups of nursing sisters in Central
government hospitals of India located in Delhi. This design was selected to produce a summary of participant
concerns and proposed solutions using
their own words in order to avoid overly interpreting comments. Institutional review board approval was granted for the
study. Support was obtained from nursing superintendent and continuing nursing education coordinator to recruit
nurses to participate in the focus groups. A convenience sample of 36 nursing sisters who volunteered to participate
was placed in four groups. Groups were assigned according to their department and years of experience. Each focus
group was led by a faculty member and a second faculty member took notes and audio recorded the session. During
the interview, the researcher, as the moderator, put forward the questions and then led the discussion strategically
when awkward silences arose, particularly during the open stage of the interview. Once the discussion warmed up,
the researcher balanced the speech time of all the participants. During the discussion, when the interviewee strayed
away from the subject, the researcher reminded them of the correct topic, so as to control the interview process. The
researcher concluded the topic and advised participants of the conclusions, to enable them to correct or complement
the conclusion. The groups lasted about 90 minutes with a 15 mts break at the halfway point.

Results
Demographics of focus group members were as follows, 28 (77.7%) undergone general nursing and midwifery
course, 26 (72.2%) undergone their training in government institutions whereas 8 (22.2%) did from mission hospitals.
Regarding exposure to in service education, 35 (97.2%) got Opportunity to attend in service education, of which only
4 (11.43%) attended in management topics, 23 (65.7%) attended in-service education in their own hospital, 31
(88.6%) attended workshop and 22 (62.9%) had attended in-service
education more than one year back. Mean age of nursing sisters were 47.33 with SD 4.78, average professional
experience was 24.47 years with SD 4.26, mean years of experience as ward sister was 7.21 with SD 6.14 and
average experience as staff nurse was 15.09 with 5.28.

NURSING SISTERS CHALLENGES: Challenges reported by nursing sisters were grouped into 3 themes:

1. Managing staff performance: The challenges of managing staff performance included sustaining staff
motivation, lack of accountability, responsibility and initiative among staff, and unprofessional attitude among staff
members and other forms of conflict. Nursing sisters described. the difficulties of lack of resources for motivating and
sustaining self enthusiasm.
1. Role Clarity(job description): There was a lack of understanding regarding the role among the nursing
Sister as well as among staff nurses. Lack of role clarity leading to inappropriate expectations of the role was a
common theme that resulted in role overload: "as time goes on, more things are added to your role’.
2. Powerlessness regarding system complexity: The High level of technology, vast amounts of paperwork
and documentation requirements and limited resources were examples of system complexities identified by
participants. Nursing sisters felt powerless in the face of these challenges. Nursing sisters expressed concern about
their inability to fully support staff nurses because they have more work to do and less help to get it done. They
described the lack of nurses input in decisions made by hospital administrators. Hospital
authority tells us what we need, but they never talk to people who do the work.

SOLUTIONS TO CHALLENGES OF NURSING SISTERS

Formal educational opportunities to learn the nursing sister role and leadership support were the main themes in
proposed solutions to nursing sister challenges. Nursing sisters wanted to learn duties and responsibilities, staff.
performance management and development, communication skills and patient relations.

1. Formal Education
Learning Responsibilities of the role: Nursing sisters explained the need for a structured orientation program to the
role. They voiced the need to rotate through other areas of the hospital to learn how to work together synergistically
and to role model others. Although the nursing sisters did not have direct budgetary responsibilities, they voiced a
need to understand how decisions are made so they could better support those deci sions
2. Managing staff performance and development:
Participants described the need to better understand other team member’s job and scopes of practice. The group
discussed the need to know how to nurture their staff and help them develop their own leadership skills.
3. Communication skills: Ongoing mandatory training in effective communication was
mentioned as a solution to eliminate confusion in patient care situations. Examples of ineffective communication
included nurse to nurse and nurse to physician, nurse to workers etc. Managing difficult patient and family situations
was another area where nursing sisters reported that formal education would be beneficial. Frictions between
patients, their families and staff become sometimes heightened.
4. Leadership support
All focus groups commented about leadership support and how good support helps incredibly, whereas lack of
support hinders their work. They also mentioned a need for their opinion to be heard and to have a voice on
committees. Nursing sisters explained that they needed their own peer group to connect with nursing sisters in other
organizations.

CONCLUSION
Nursing sisters are not adequately prepared and oriented to carry out their role. Hospital Administrators and Nursing
administrators need to organize orientation programmes and in~service education programmes to orient and update
nursing sisters on management techniques. Nursing sisters should utilize every opportunity to empower them as a
responsible and accountable leader of her team in the ward to provide quality health care to the patients.

REFERENCES :

1. Jogindra Vati, “Principle and Practice of Nursing Management and Administration for Bsc and Msc
nursing”,jaypee brothers, edition-1st , page no-81-92
2. Deepak kumar, Comprehensive textbook on Nursing Management, Emmess medical publishers, edition-1st
pg no-135-157
3. Sukhbir Kaur, “Textbook of Nursing Management and Services for Bsc and Msc nursing”,jaypee brothers,
edition-2013, page no-101-129
4. Kumari Neelam, text book of management of nursing services and education, Edit ion 2011, pg no. 105-117
5. Stephanies, Principles & practice of nursing, 2 nd part, edition 4th , N.R Publication, pg no- 218-227
6. Basvanthappa, textbook of nursing management, jaypee brothers, edition 4 th, page no: 8-12
7. Gillies, nursing management and administration, Elsevier, edition 1st , page no-20-28
8. http://www.ncbi.nlm.nih.gov/pubmed/5185110
9. http://www.slideshare.net/rsmehta/12-trends-and-issues-in-nursing
10. http://www.nsgmed.com/management/current -trends-and-issues-in-nursing-management-part-3/
11. http://nursingon.blogspot.in/2015/06/current-trentds-and-issues-in-nursing.html
12. http://onlinenursing.wilkes.edu/trends-in-nursing
13. https://www.researchgate.net/publication/240711144_Current_Trends_and_Issues_in_Nursing_Management
14. Article by mr dilip kumar, president of TNAI

RAJKUMARI AMRIT KAUR COLLEGE OF NURSING, LAJPAT

NAGAR, NEW DELHI
NURSING MANAGEMENT
MASTER OF NURSING-3RD SEM

PRESENTATION
On
AIMS,OBJECTIVES,PHILOSOPHY,
 CURRENT ISSUES AND TRENDS IN
NURSING MANAGEMENT
AND ADMINISTRATION

ADVISOR : DR. (MRS) MOLLY BABU

HOD (OBG & GYNE)
R.A.K.C.O.N
SPEAKER : Ms SAVITA
M.Sc NURSING